Work

Sequential Treatment of Generalized Pustular Psoriasis Combined with Bullous Pemphigoid Using Spesolimab and Dupilumab: A Case Report and Literature Review

Year: 2025

Type: article

Abstract: Introduction: Generalized pustular psoriasis (GPP) and bullous pemphigoid (BP) are two distinct but occasionally coexisting inflammatory skin disorders. Their simultaneous presence presents diagnostic and therapeutic challenges. Spesolimab and dupilumab are novel biologics targeting the IL-36 and IL-4/IL-13 pathways, respectively. However, their sequential use in treating GPP with BP has not been previously reported. Case Presentation: We report a 58-year-old man with a 10-year history of psoriasis who developed acute GPP followed by BP. Initial acitretin therapy resolved pustules but not bullae. A single dose of intravenous spesolimab led to rapid improvement of systemic symptoms and pustular lesions. Persistent bullae were subsequently treated with dupilumab (600 mg loading dose, then 300 mg biweekly), resulting in complete resolution within 2 months. The patient remained relapse-free for 6 months, with no adverse events. Conclusion: This case highlights the potential of sequential spesolimab and dupilumab therapy as an effective and safe approach for managing GPP coexisting with BP. Targeting distinct inflammatory pathways may provide a new treatment option for complex dermatological comorbidities.

Source: Case Reports in Dermatology

DOI: 10.1159/000547774

Authors: Ying Wang, Haoyu Yang, Zhihong Zhang, Hongda Yu, Lei Wang, Yanping Bai

Institutions: China-Japan Friendship Hospital, Beijing Hospital of Traditional Chinese Medicine

Language: English

Topic: Psoriasis: Treatment and Pathogenesis

Subfield: Immunology

Field: Immunology and Microbiology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,030